Vasopressors in Septic Shock: An eICU Database Study

Introduction: Septic shock is managed in intensive care units (ICU) with markedly high mortality rates despite adequate management. Vasopressors are the cornerstone of management, yet evidence comparing outcomes, by specific agent, is still limited. This study aims to evaluate the impact of vasopressors on mortality, survival and hospital length of stay in septic shock patients admitted to the ICU.


Methods: The eICU-CRD database, a publicly available de-identified database, was used for statistical analysis. 1,606 patients admitted for suspected or confirmed septic shock were isolated and stratified by vasopressor type including: dobutamine, dopamine, epinephrine, milrinone, norepinephrine, phenylephrine, vasopressin and non-vasopressors. Demographic data, mortality, survival and ICU length of stay were then quantitatively analyzed by vasopressor administration groups. Analysis included Kaplan Meier survival curves and chi squared analysis for mortality and overall clinical outcomes.


Results: Mortality, survival and ICU Length of Stay were statistically different among all groups. Mortality was greatest in the patients receiving Epinephrine (75%) and Milrinone (66.7%) and lowest in the patients receiving Dopamine (12.8%, p< 0.001). Survival was greatest in the dopamine and dobutamine groups and lowest in the epinephrine group (p < 0.001). Length of stay was greatest in the patients receiving milrinone and shortest in the patients receiving epinephrine and phenylephrine (p < 0.001). Overall, norepinephrine had modest reductions in mortality and length of stay and increases in overall survival. Increased survival rates associated with dobutamine over epinephrine suggest that there could be stronger evidence supporting its use in septic shock management.


Conclusions: Dobutamine historically has had weak evidence to support its use in septic shock management but the increased survival rates in this study suggests that it should be further considered in the sepsis hour-1 bundle. Future studies should evaluate the inclusion of drugs such as milrinone and phenylephrine in improving outcomes of septic shock patients.